Jul 20, 2020
By Monica S. Chatwal, MD
Fellowship is an exhilarating and stressful culmination of medical training. In hematology/oncology fellowship, in particular, it is challenging to keep up with the rapidly changing landscape of newer diagnostic mechanisms, targeted therapies, and personalized medicine.
And then came COVID-19, a novel coronavirus unknown to the world and a pandemic on a scale that has not been seen for a century.
For ASCO members in any career phase, spring and early summer would usually be filled with anticipation and eager excitement for the ASCO Annual Meeting in Chicago and the opportunity to meet and reconnect with our national and international colleagues, mentors, and friends. Although the transition to a virtual program is a remarkable endeavor, for trainees who looked forward to attending the ASCO Annual Meeting for the first (or perhaps second or third) time in 2020, the disappointment of missing those personal connections is equally felt.
The ASCO Trainee Council acknowledges that this monumental shift in the world and in medical practice due to COVID-19 will certainly have an impact on oncology trainees and early-career oncology professionals. In response, we developed COVID-19 Topical Calls: videoconferences to reconnect in an informal way with peers and colleagues. The first (in what we hope will become a series) was held in April. I served as a co-moderator along with two other members of the Trainee Council, Neil Shah, MD, and Swetha Kambhampati, MD; 45 fellows joined the call.
The call focused on three topics; the discussion and some suggested recommendations are summarized here.
How has COVID-19 affected your fellowship training?
Most outpatients have transitioned to virtual visits or have been rescheduled to later dates, with fellows now adapting to the change in learning environment. Continue to prepare for clinic and join in on telemedicine calls with attendings. This helps trainees gain experience in virtual medicine, which will likely become a more permanent part of our practices.
Many fellows have been pulled from regular inpatient services to limit the use of personal protective equipment (PPE). Those in more severely impacted cities have also been asked to cover general medicine inpatient or intensive care unit (ICU) services. Early-career oncologists have been asked to cover COVID-19 patient services, as well. We were able to hear firsthand from some members in these positions and commend them for their adaptability and persistence.
Didactics and conferences have been shifted to a virtual format to adapt to the need for social distancing. This may actually evolve into more virtual learning opportunities in the future for trainees, with greater possibility for inter-institutional collaborations.
Participants also expressed concern regarding the impact on research projects and opportunities. Though most basic science and lab research has been halted, some aspects of research could still be continued, including data collection and analysis. COVID-19 has also unveiled a number of unique research opportunities, particularly in evaluating effects on cancer care.
How has COVID-19 affected your job search or transition to early career?
Trainees expressed significant anxiety about their transition out of fellowship in finding jobs amidst the pandemic and subsequent economic downturn. There is still quite a bit of uncertainty about how COVID-19 will impact our career transitions. Despite talks of hiring freezes and noticeable decreases in patient volumes, we suspect there is still job security for physicians, in particular for hematologists and oncologists.
We recommend reaching out to program directors, mentors, and colleagues at both internal and external institutions to learn more about job opportunities. Additionally, ASCO publishes positions online in its Career Center and in print in many of their journals, including the Journal of Clinical Oncology (JCO).
Stay flexible and open to different opportunities that may be available. These may not be your first choice or have all the benefits you hoped for, but can still serve as very valuable building blocks for future career transition and development.
How are you managing stress or burnout in your professional and personal life?
Now more than ever, physicians need to quickly recognize signs of stress and burnout. These are inevitable during the pandemic and can have long-term consequences.
Those trainees on the front lines caring for COVID-19 patients are even more at risk. They are constantly facing the burden of exposure, often in the setting of limited resources. Many are self-isolating so as not to contaminate their homes or put their families at risk; others feel guilty that their exposure may increase the risk to their loved ones. They are struggling to relearn aspects of intensive care and general medicine that they may not have practiced for several years.
We are all struggling with how to provide the best possible cancer care for our already immunosuppressed patients. Sometimes this results in difficult discussions and decisions on forgoing or delaying therapy.
At home, we are learning how to stay sane while having to take on several new roles—homeschool teachers, extended caregivers, sharers of home offices, home chefs, and more. Self-care may not be high on our list of priorities, but it should certainly be incorporated into our now pandemic-driven lives, even in the smallest of ways.
With too much out of our control, we should focus on what we can control. Eat well, stay hydrated, go on walks or runs, and exercise (at appropriate distances). Maintain day-to-day routines—wake up, shower, set up your designated “office area”—to preserve a sense of regularity and stability. Call your family and friends frequently to check in. They are worried about you and want to know you’re doing okay. With the all-too-important social distancing, it is unfortunately too easy to become isolated.
This drastic and deadly virus has seismically altered everything: society, medicine, and our future course. With these trainee-directed topical calls, we hope to try to adapt to the rapidly changing landscape and remain connected, even in some small way.
Stay up to date on future topical calls through the ASCO myConnection Oncology Trainee Community or email firstname.lastname@example.org for more information.
Acknowledgment: I would like to thank Dr. Shah and Dr. Kambhampati for co-moderating the first COVID Topical Call. I would also like to thank Natalie Holloway at ASCO and the ASCO Trainee Council team for helping to organize.
Dr. Chatwal is a medical oncologist at Moffitt Cancer Center with a focus in genitourinary malignancies. She has a practical and research interest in provider burnout, particularly for trainees. She has served on the ASCO Trainee Council since 2018 and is currently the wellness representative to the Graduate Medical Education Committee at Moffitt.